Purpose or Case Report: The formation of one or more intestinal strictures is a known complication of necrotizing enterocolitis (NEC). Multiple prior investigations have found that the occurrence of colonic strictures is higher than small intestinal strictures, at an approximate ratio of 2-3:1. We hypothesized that small intestinal strictures may be more prevalent than colonic strictures at our urban, academic, tertiary care children’s hospital.

Our first aim was to determine the incidence of small intestinal and colonic strictures in patients with prior medically treated NEC who had not undergone previous surgical intervention. Second, we attempted to evaluate for differences in demographics and other clinical variables between the group of patients with small intestinal strictures versus the group with colonic strictures.
Methods & Materials: Infants who had undergone fluoroscopic imaging studies for the evaluation of intestinal strictures following medically treated NEC were included in the study. Of the 49 patients identified, 15 patients were confirmed to have had stricture formation during subsequent surgical exploration. For each subject the following demographic and clinical data were collected: gender, birth weight, gestational age at birth, age at first diagnosis of NEC, number of episodes of medical NEC, and age at surgery for evaluation of stricture.
Results: 5/15 (33%) subjects had strictures limited to the colon, 8/15 (53%) subjects had strictures limited to the small intestine, and 2/15 (13%) subjects had both small intestinal and colonic strictures. Therefore, the overall incidence of colonic stricture was 7/15 (46.7%; confidence interval: 25-70%) and the overall incidence of small intestinal stricture was 10/15 (66.7%; confidence interval: 42-85%). There was no statistically significant difference in gender, birth weight, gestational age at birth, age at first diagnosis of NEC, number of episodes of medical NEC, or age at surgery between the group of patients with small intestinal strictures versus the group with colonic strictures (p-values range from 0.13 to 0.77).
Conclusions: Small intestinal strictures are more common than colon strictures in our population of patients with medically treated NEC. This is contrary to the findings of most prior investigations that found colonic strictures to be most common. There was no statistically significant difference in patient demographics between the groups, limiting our ability to predict what type of stricture a patient might develop.